Researchers are testing a new pill to treat postpartum depression.  I am happy to hear there will be more options for those who have postpartum depression.  However, I see the same pattern again.  Mainstream medical care focuses on treating the symptoms, but it isn't all that proactive at addressing the causes. 

Postpartum depression affects the entire family, not just Mom.  It is estimated that up to 25% of partners will suffer with postpartum depression, and that number skyrockets to 50% if Mom has postpartum depression.  In 2018, the results of a study done in the United Kingdom shows that postpartum depression affects the children in the home.  The children have developmental delays, higher rates of behavorial problems, are more likely to drop out of high school and are more likely to struggle with depression in the teen years.  Postpartum depression has a ripple effect that can last for years and affects more than just the mother.

Outcomes would be better, recovery times would be shortened and families would be healthier and happier if we gave priority to eliminating or reducing the causes of postpartum depression instead of developing an IV treament or pill to treat the symptoms of postpartum depression.  From an economic standpoint, heading off postpartum depression before it starts would reduce health insurance costs, and keep the family from having decreased earnings as a result of the family having to navigate life when one or more members is dealing with postpartum depression.  

What would happen if we actually supported women and families during the postpartum period?  What if we talked about what to expect in the postpartum period instead of glossing it over?  What if we normalized that postpartum can be a challenging time?  What if we sent midwives to check in with mothers before the six week appointment?  What if we did more than a phone call in the first few days after birth to check on the family?  What if support for new families involved more than a meal train the first week or so?  What if someone came in a few hours a day to do laundry, dishes, floors, and maybe stay with baby while the parents get a shower and take a nap?  What if our country decided to join the rest of the industrialized world and instituted a national policy requiring paid parental leave?  What if we stopped focusing on the short term costs, and started focusing on the long term benefits of investing in and supporting new and growing families?

Postpartum is a wonderful, challenging time.  As a midwife, I try my best to help families smooth out the rough spots and manage the challenges.  I am a huge fan of postpartum planning.  Doing more postpartum visits than just the one at 6 weeks is one way I am making a difference.  Checking in more lets me assess how well mother is recovering, and to monitor for unwelcome things like postpartum exhaustion, anxiety and depression.  Being able to catch these things early is key to keeping mothers and families safe and healthy in the postpartum period.  There is a saying that an ounce of prevention is worth a pound of cure.  I agree and as a home birth midwife,  I feel I am making a difference by focusing on prevention so families don't have to suffer while they wait for a cure to kick in.

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Postpartum is a truly unique time with both challenges and exquisite joys. Movies and TV shows perpetuate the myth that postpartum is a time of great happiness and joy, while making light of the less pleasant aspects. We don't have a lot of conversations about the reality of postpartum life, and reality and fiction rarely match up.

Postpartum can be challenging.  Mom and Dad are adjusting to having a new family member who is totally dependant on them for everything.  Mom is facing the reality if she is breastfeeding that she is the 24 hour  all you can eat buffet for baby.  Mom is also dealing with being sore from labor and birth, having bleeding and maybe leaky breasts that turn on and off at random when baby isn't nursing.  Dad is trying to figure out how best to help Mom while learning that there are some problems that he can't fix for Mom.   Both parents are navigating all this while in a very sleep deprived state, and may be getting all kind of conflicting advice about sleep, feeding, holding baby etc from friends, family and caregivers.  

Don't get me wrong, postpartum can be wonderful.  Baby is here and Dad can finally touch and hold him or her.  There's nothing to match the feelings of seeing your baby's first smile, or hear that first belly laugh, not to mention the delight in locking gazes with baby. There is a special joy in knowing someone is so dependant on you and that you can take care of them.  

There are things you can do to set yourself up to have an easier postpartum, or fourth trimester.    One of the most important things you can do is to have help available for the first 2-3 weeks postpartum.  Maybe a family member stays with you and helps with meals, cleaning and all the household duties so the parents can focus on baby and recovering from pregnancy and birth.  Some families hire a postpartum doula to help, or they have someone arrange for a meal train, and use delivery services for groceries, diapers and other necessities of life for the first few weeks.  Having some easy to prep meals, or freezer meals on hand is another great way to prep for postpartum.  Having a diaper changing station, or basket with all the diaper necesseties to keep close at hand when baby is here, as well as a snack station for mom are other ways to make postpartum a little easier, especially if you are not able to arrange for someone to always be around in the first few days and weeks.  

You get to decide what you want your postpartum time to look like.  Maybe it includes things like dates and times you will be able to receive visitors. I personally recommend that any visitors have a job do to like laundry, cooking, dishes etc as part of the visit (you could have a list of things you want help with for visitors to pick from).  Maybe there's a scheduled time for Dad to go hang out with friends, or Mom steps out to get a pedicure.  Maybe you have a list of older siblings' favorite games, movies, or places to visit for friends and family who want to help with siblings.  The options are endless, so think through what you feel you will need, and what you want.  Consider making a written postpartum plan which can help with communicating your needs and desires with others.  You can share it with family and friends who are going to be part of your support team.  Remember, it is your postpartum and not anyone else's so do what you need to do to have the postpartum you need and want.

Scale and sling: At every postpartum, I will weigh baby to monitor weight.  Babies typically lose weight in the first few days after birth and I want to track this.  It is normal for a baby to lose up to 10% of birth weight.  I like to see that baby is gaining weight and is close to or back at birth weight at the two week visit. 
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Stethoscope and blood pressure cuff: I also take Mom's blood pressure at each postpartum. Blood pressure numbers can tell me how well the body is handling birth related blood loss and helps me monitor for postpartum preeclampsia.

Pulse-oximeter: I carry a pulse-oximeter to use on baby to check for critical congenital heart dieases if parents want the check completed.

Newborn heel lancet and Kansas newborn metabolic screening collection form: I use these to collect five blood drops for the state to complete the metabolic disease screening.  Parents can decide if they want ths screening completed.

My hands: I like to palpate the uterus at the first 2 or three postpartums to check how quickly it is going back to pre-pregnancy size.

Questions: I ask lots of questions.  I'll ask about nursing, Mom's sleep and appetite, how everyone is adapting to baby and many more questions.  Questions help me assess how things are going and give me the opportunity to help everyone navigate any issues that may come up.  

My most important tools:  I feel my most important tools are asking questions and listening well and trusting parental intuition. 

Postpartum is wonderful and exhausting at the same time. Rest, good support and evidence based information can all contribute to a wonderful postpartum period. My goal in the postpartum period is to work together with parents and baby to help them have the best postpartum time they possibly can have.